Doctors Say EHRs Are Good for Storage, But Risky for Patient Relationships and Burnout

Doctors have a complicated relationship with electronic health records (EHRs): two-thirds of primary care providers (PCPs) see value in digital records (EHRs), but at the same time believe the technology has weakened relationships with patients, detracted from clinical effectiveness, and lack streamlined user experience. That deficiency is, in three words, lack of interoperability; that challenge has required one-half of physician-users to use work-around’s to make their EHR investments more useful.

These insights come out of a survey conducted among primary care providers by The Harris Poll for Stanford Medicine, published to coincide with the medical school’s convening of the EHR National Symposium held on June 4, 2018.

The poll was conducted among 521 PCPs in March 2018.

The infographic summaries some of the points emerging from the study. Among the major findings:

• While most are at least somewhat satisfied with EHRs, most report problems resulting in 4 in 10 doctors saying there are more challenges with the technology than benefits
• Tw0-thirds of time spent with patients are with the EHR; one-half of PCPs say using an EHR detracts from clinical effectiveness (only 8% say the primary value of their EHR is clinically-related)
• 7 in 10 PCPs believe EHRs greatly contribute to physician burnout
• Six in 10 doctors think EHRs need a “complete overhaul.”

The top value of the EHR is digital storage, according to nearly one-half of PCPs. 

The second chart illustrates the gap between doctors’ EHR wants versus EHR abilities. Physicians’ top-ranked importance factor for EHRs is to maintain a high-quality record of patient data in the EHR over time, with virtually 100% agreement among doctors (99%). This importance factor is closely followed by providing an intuitive user experience (97%), sharing information with providers across the care continuum (95%), coordinating care for patients with complex conditions (94%), change or adapt in response to user feedback (91%) and facilitating better patient-provider interaction (91%).

Each of these issues has a reality gap in terms of EHR performance: the chart orders those issues from the largest to smallest gaps.

Health Populi’s Hot Points:  The latest 2018 Medscape survey into physician wellness was titled the National Physician Burnout & Depression Report. Doctors pointed to administrative task burdens, largely to do with their EHR systems, contributing to burnout among 56% of physicians.

Medscape’s research has consistently found that 42% of doctors feel burned out in 2018. Primary care physicians in internal medicine, OBGYN, and family medicine have even higher rates of burnout.

Most physicians want more time to spend with patients. Most physicians rarely have time to address all patients’ questions and concerns, the third chart from the Stanford/Harris survey shows.

Most physicians blame EHRs for taking valuable time away from patients.

These are the unintended consequences of the HITECH Act, which funded healthcare provider investments in electronic health records. In historical context, HITECH was part of the ARRA Stimulus Bill, legislation meant to bring the Great Recession Economy back to life. Digitizing records underpinned this with the long-term goal of helping reduce health care costs in the American macroeconomy, especially to help make Medicare and Medicaid more sustainable over time.

The costs of implementing EHRs go well beyond direct expenses of the computer systems and staff time devoted to making systems “work.” Interoperability wasn’t baked into the original legislation. Neither was an objective to enchant users with streamlined experience.

This is where we are now in American healthcare: physicians want more time with patients.  Patients want more effective relationships with physicians, sharing decisions, better understanding therapeutic options and of course, what personal costs will be for various healthcare decisions. Some healthcare systems are innovating to improve care at the nexus of patient and provider: the growth of Open Notes and Our Notes is bolstering the patient-physician relationship. See the latest announcement from UPMC about expanding Open Notes access to patients via the patient portal.

Voice technology (THINK: Alexa-meets-the-EHR) and the adoption of APIs (application programming interfaces) can “appify” the EHR from the inside out, to enable greater interoperability and sharing of information across the care continuum and between providers. It’s encouraging to see the Stanford/Harris survey find that among physicians using voice recognition technology, 62% are at least somewhat satisfied with it.

Adopting these new digital tools, when they can positively impact the doctor’s workflow and patient life-flow, will help to improve the EHR experience for both doctors and patients. How quickly these will be adopted into mainstream practice remains to be seen: sooner, better. If not, EHRs are a very expensive data storage option.

And there’s always the “overhaul” of aligning with Apple via the just-announced API for EHRs…

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